A salutary tale of prescription drugs and geriatric care…

Once upon a time, for isn’t that how all great stories start…

Once upon a time, I was clearing the boot of my mother’s car. It’s a good start, not a great start I’ll grant you, no princesses and dragons here…

But hang on, I suppose I should step back a bit, to give you a clearer picture of the reasons why I’m telling you this story.

My father died 12 years ago, leaving my mother on her own. I’m an only child. Keeping in touch isn’t always easy as I moved to Ireland many years ago and she still lives in England. I try to make it over as often as I can, to check up on her and I call her, though not as often as I should. She’s a solitary person and rarely lifts the phone, so the conversation is very one-sided. But that’s the rhythm we’ve settled into.

She always had problems with her ‘nerves’ and has been on low-dose benzodiazepines for as long as I can remember. My father’s death affected her gravely. He was a very dominant, loud and gregarious man and my mother lived her life in his shadow. She was happy with the balance and losing him was a shock, even though he’d been ill for years with leukaemia and his passing was not unexpected… that’s a story for another day.

In the months after his death, she had trouble sleeping and was distraught. Her doctor was very supportive and offered her any number of possible interventions. When I say supportive, I have a feeling he was a little too supportive and a little too fond of the BMA book in his desk.

My mother is a creature of habit and there’s a spot on the end of the kitchen worktop where she keeps her prescription medicines. Every time I went home to visit, the paper pharmacy bags had multiplied. I was concerned, though not too much, as my trust in the NHS system is still strong, having grown up with free healthcare and a belief that doctors are there to look after the best interests of their patients… Hippocrates and all that.

As the anniversaries of my father’s death passed, I noticed a change in my mother’s health. Nothing sudden, nothing immediately alarming. She is aging, as we all do, but her concentration levels were dipping. She was sleeping every afternoon and by nine in the evening she was drooping. My mother likes a glass of wine or two. Five o’clock every evening she opens the Merlot and by six, she’s drunk both glasses. I put her sluggish sentences and memory loss down to age and the booze.

So here we are, back at once upon a time…

I decided to clear my father’s office and take the junk to the council dump. The old Focus Estate was ideal. I pulled down the back seats to make as much space as possible and lying beneath them was a printed prescription; my mother’s name at the top and a list of thirteen different drugs. I couldn’t quite believe the number of medications, though I should have suspected something due to the proliferation of those pharmacy bags.

My mother lives in an age before internet. There’s no WiFi, no connectivity and the 3G signal at the time was all but useless. I took the prescription to my bedroom and texted my wife back home in Ireland, each and every …am and …ex and …ine.

My wife Googled them one by one; a benzodiazapine, an anti-psychotic, an SSRI, a bladder control drug, a diuretic, a high blood pressure drug, something to lower blood pressure, an anti-histamine and a something to help with IBS. That’s it from memory, I’ve forgotten the others. The texts went on for half an hour or so, as the side-effects and contraindications flew through the ether from Ireland.

I said nothing to my mother. She places huge trust in the doctors and the pills they give her. Her faith, I think, is due to a passive acceptance that a new pill can cure the problem. I also think her doctor believed the same. He has since retired and I can’t and won’t say he was at fault, but maybe he saw an old woman with multiple health problems and decided to throw the BMA book at her to help her pharmaceutically in any way he could. Maybe he thought that doing no harm was the best thing for my mother, despite the potential interactions. He always seemed a decent fellah and was a great help during my father’s illness, and that’s maybe why my mother trusted his judgement.

A couple of days later after the three trips to the dump and a Ryanair flight home, I sat at the computer and went through the list again. I did a year of bio-chemistry at University before dropping out to follow my theatre career. A little knowledge can be a bad thing, but I felt equipped enough to read the more academic parts of the Google searches. I also felt very unequipped in knowing what to do about it all when the plain truth of contraindications and polypharmacy problems came out of those searches. So I sat down and wrote a long letter to my mother’s Surgery.

I didn’t keep the letter but I remember it went along the lines of… (and I’m paraphrasing here)

Concerned son, blah blah… anti-psychotic, SSRI and benzodiazapines, for mild depression??? You have to be kidding… blah blah… bladder control and diuretics… surely not? Polypharmacy prescriptions… handing them out like sweeties… yours sincerely, etc. etc.

I was polite but my concern was plain enough. I expected very little in reply but the Surgery wrote back. They informed me of their requirement for patient confidentiality, said I could come in with my mother if I was concerned but that she would have to be there to discuss any issues and if I had any further concerns, I should let them know.

Their letter was polite and they acknowledged my genuine concern but I felt they were not going to do anything unless I broached the subject with my mother.

But, and here’s the final few lines, just in case you’re wondering…

The next time I went over to visit, the pharmacy bags had decreased, the pill count was down, the SSRI’s and the anti-psychotics had gone and the prescriptions were a lot shorter. My mother was unaware of my letter but told me that her new, young Doctor, had been reducing her drugs and dosage across the board.

My mother still has her pills to rely on, still drinks her wine, still sleeps in the afternoon, but she can manage a whole episode of Poirot without drifting off into La-La land. She remembers to ask about my life and the kids, she remembers birthdays and our conversations aren’t filled with gaps of memory and trailing sentences.

I can’t say she’s cured of her ills, but I can say for sure that she’s a different person to the drug-stuffed woman, who could barely keep her eyes open. I suppose that’s as good as a happily ever after as one can wish for.

We are carers; first as parents and then as children to our own parents. We have a responsibility to challenge what we see as wrong.

The medical profession are human; most likely overstretched and under-resourced. The drugs are easily prescribed and interactions are, for the most part, un-researched. The medical profession, doctors and pharmacists, have a responsibility to their patients as carers too.

As carers, we all need to work in the individual’s best interests. In my own mind, it seems that conversations about medication and frequent reviews of those medications are a necessity, especially in geriatric care.

I don’t blame anyone for what happened to my mother, but it is a salutary tale of a system that treats both mental and physical symptoms with yet another pill, often with little regard for the consequences.

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